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About More Voices

Every month More Voices invites readers to contribute short nonfiction prose pieces of 40 to 400 words on a healthcare theme.

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I worry that in the future, doctors won't touch patients. When I put my hand on the foot of a dying patient--and feel that it is still warm and offer measured encouragement--I am doing the work of this profession.

Telemedicine, on the other hand, is part of another world; I don’t wish it to go away, but that it coexist with the tactile, earthy, demanding, inconvenient reality of patients' bodies.  

The climate of medicine has become too technocratic, too money-obsessed. Nurses still touch patients, but the insecurity and ineptitude of bedside physicians is now stunning. I heard an otherwise sensible senior resident say, "The physical exam is obsolete." Of course it is not, neither diagnostically nor therapeutically, but the prophecy of disuse will become self-fulfilling. Unexercised muscles atrophy apace.

I worry that already there are not enough allies among physicians and teachers. I worry that advanced practice nurses now feel compelled to earn doctoral degrees and may soon be pressed into the same hands-off approach that besieges physicians. I worry that bedside nurses--another endangered species--will lose yet another crucial ally and that we will no longer be able to talk to one another about patients, only about their BUN levels and their rituximab injection and the FDG avidity on their PET scans.

I worry that patients will thereby be deprived of comfort and of efficient and holistic care.

I worry about the mental health and the fulfillment of midcareer caregivers.I worry about their disconnect from idealism. I worry about who will choose this work once the word gets out that we have allowed ourselves to be degraded to technicians. 

I worry that my forceful advocacy for bedside contact, for its daily incorporation in my practice and in my notes as a central tenet and not a tick-box of compliance, will be viewed as ever more antiquarian, cute, unrealistic, and out of the mainstream--and ultimately with pity and contempt. I worry that I will be perceived, unjustly, as an old-fogey curmudgeon, out of touch with the glory of infinitely pricey, infinitely impersonal medicine. That would be theultimate irony not because I can't take it (I know who I am), but because it would mark the loss of something we cannot do without.
 
Henry Schneiderman
Hartford, Connecticut